A 20-year-old previously healthy man presented with progressive rash, low-grade fever and arthralgia that involved the knees and ankles that had lasted for 2 months despite treatment with oral prednisolone and naproxen, arthralgia is under control, but rashes developed more.

A 73-year-old female Singaporean was seen in this clinic in September 2010 because of numerous vesicles base distributed mainly on arms and both lower limbs (Fig.1-A), the skin on her both ankle and dorsum of feet is dry, red, scaling, and thickened.